罕见的肺外结核:隐藏的症状和诊断困境
Guddi Rani Singh1, Anila Sinha1, Anushweta1
1Department of Pathology, and Department of Microbiology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar 800014, India.
概括
肺外结核,罕见但严重,可以通过组织病理学,Ziehl-Neelsen染色以检测酸性细菌,以及GeneXpert检测Mycobacterium结核病DNA来诊断. 早期诊断对于有效治疗至关重要.
科学领域:
- 医学微生物学 医学微生物学
- 病理学 病理学 病理学
- 传染性疾病 传染性疾病
背景情况:
- 肺结核可以扩散到其他器官 (肺外结核),如果没有早期检测或免疫力低下的个体.
- 罕见的部位包括胃肠道,肌肉骨系统,生殖道,中耳和心周.
- 诊断依赖于表观病理学显示的颗粒瘤,Ziehl-Neelsen对酸性细菌 (AFB) 的染色,以及GeneXpert对Mycobacterium结核病DNA的染色.
研究的目的:
- 评估组织病理学,Ziehl-Neelsen染色和GeneXpert在肺外结核病的诊断效用.
- 评估这些方法在活检样本中识别Mycobacterium结核病的准确性.
主要方法:
- 活检样本的组织病理学检查,以检测颗粒瘤和瘤.
- 齐尔-尼尔森 (ZN) 染色用于酸性细菌 (AFB).
- 在活检样本中检测Mycobacterium结核病DNA的GeneXpert MTB测定.
主要成果:
- 在10个病例中,有8个病例性亡,有7个在ZN染色上为AFB阳性.
- 在10例中,GeneXpert在9例中检测到Mycobacterium结核病DNA.
- 组织病理学和ZN染色在大多数情况下发现了颗粒瘤和AFB,而GeneXpert显示出更高的灵敏度.
结论:
- 肺外结核病往往是肺结核的次要病,以血源性传播.
- 它带来了诊断挑战,在慢性,不反应的病例中应该考虑.
- 使用ZN染色的活检对于初步诊断是具有成本效益的;GeneXpert对于确认是有价值的,特别是在负ZN染色或不存在缩的情况下.
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